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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT e CALL(2J109 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS a ��D /V ! ))Om n- /t yc./'-- CITY/ZIP L <br /> CROSS STREET CYC APN1_X)7_--?2 7_6 PARCEL SIZE C <br /> ✓J d <br /> OWNER NAME Y� vV T S4-z/071 <br /> /- PHONE <br /> OWNER ADDRESS PopV/X [ O 7/ CITY/STATE/ZIP <br /> CONTRACTOR !?L !/ I�C lr PHONE �76 <br /> CONTRACTOR ADDRESS 3706 l uz ^/k LL <br /> G CITY/STATE/ZIP <br /> LICENSE ❑gk-42 ❑EC-36 OTHER NUMBER 7 SIDYS EXPIRATION DATE <br /> WATER TABLE DEPTH: L O ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# p l�VSybZ LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION L. ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: i�, RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG J �" CAPACITY ���`' gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL / ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES 55' ft <br /> DISTANCE TO NEAREST WELL �,G' ft FOUNDATION ft PROPERTY LINE 75 f ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ''/Jft FOUNDATION ft PROPERTY LINE ft <br /> 51 SEEPAGE PITS NUMBER ?I WIDTH 50 ft DEPTH 2S, ft <br /> DISTANCE TO NEAREST WELLS SD ft FOUNDATION 50ft PROPERTY LINE 7�� ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS�- PLEASE CALL 209 953-7697 <br /> SIGNED TITLE i may,/1'L/K�'� DATE JZ /7 �'51 <br /> N <br /> F T <br /> r <br /> EPARTMENT SEIbONLY <br /> Application Accepted B. Date �i ( Area Employee ID# <br /> Final Inspection By Date iI'7_ "` ZAl`l ❑ SPEC AL PERMIT-Approved by <br /> Character of Soil to ep of 3 F• ���,/�0� Pit/Sump Soil Character: Lwtdj Sd4f y� S C LT l C3t�P� <br /> COMMENTS�� lU�� #A 9:; <br /> PE SC Received heck# Amount Permit/ <br /> Code INFO Cash emi ed Date Service Request# Invoice# Permit ID# <br /> t <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />